Physicians affected by California fires will be granted automatic MIPS exceptions

December 01, 2017
Area(s) of Interest: MACRA Payor Issues and Reimbursement 

The Centers for Medicare and Medicaid Services (CMS) recently released regulatory guidance for clinicians participating in the Merit-based Incentive Payment System (MIPS) who have been adversely impacted by recent natural disasters, including the Northern California wildfires.

The "Extreme and Uncontrollable Circumstances" policy grants MIPS-eligible clinicians exceptions without having to submit an exception request. This automatic extreme and uncontrollable circumstances policy only applies to you if you’re an individual MIPS-eligible clinician in an affected area [determined by zip code and based on information in the Provider Enrollment, Chain and Ownership System (PECOS)].

Under this policy, physicians affected by the Northern California wildfires will automatically receive a neutral MIPS payment adjustment, unless they submit data for any of the MIPS performance categories by the 2017 submission deadline. If you do submit MIPS performance data, you will be scored on each performance category for which you submit data, according to existing MIPS scoring policies.

This policy does not apply to MIPS-eligible clinicians in alternative payment models in 2017, such as the Medicare Shared Savings Program.

The affected areas in California include Butte, Lake, Mendocino, Napa, Sonoma, Orange, Nevada and Yuba counties.


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